12 Best Exercises for Knee Pain Relief

Not All Knee Pain is Created Equal

We must first understand that there are different types of knee pain. I would divide these into two different main categories. 

The two categories of knee pain are:

Traumatic Onset vs. Non-Traumatic Onset

Traumatic injuries are simply injuries to an area that occur suddenly and usually are accompanied by a severe onset of knee pain. Traumatic knee pain is often the result of ligament tears, meniscus tears, and bone fractures. These topics will be covered in future posts.

Non-traumatic injuries, which will be discussed today, are often associated with a gradual onset of knee pain. This pain is usually attributed to disorders such as Patellofemoral Pain Syndrome, knee osteoarthritis, patellar tendinitis, chondromalacia patella, or Iliotibial Band (IT Band) Syndrome.

Why Does My Knee Hurt?

Non-traumatic causes of knee pain typically include joint degeneration or overuse injuries. Knees are especially susceptible to a multitude of forces acting upon them throughout our lifetimes. Our knees are constantly dealing with immense forces going through them as we walk, run, jump, climb, kneel, fall, etc., throughout our lifetimes. The cartilage will eventually wear it out.

I always tell my patients, “it’s like the tread on tires, it’s guaranteed to wear out eventually.” Then, add in some tightness on one side of your knee combined with weakness on another and, “Voila!” Here comes your most recent onset of knee pain. 

Overuse injuries occur when we expose tissues in our bodies to forces that they are not accustomed to. These injuries typically occur in our muscles, tendons, and bones. The work capacity of each tissue is not enough to endure the constant stress that we place upon it. Our bodies are able to recover from these stresses for shorter amounts of time. However, if exposed over long periods of time, eventually, this tissue will start to break down and become irritated. This is an overuse injury and I see it quite often in the knee.

The tissues most commonly involved in producing this type of knee pain are the cartilage directly underneath the patella (a.k.a. knee cap), the tibial plateau, the femoral condyle, the IT Band, and the patellar tendon.

Regardless of the specific cause of the knee pain, the role of strengthening and stretching the tissues that cross over the knee joint is critical as we want to create an optimal environment of support for these structures.

Today, we will discuss knee strengthening exercises best suited to help relieve pain caused by Patellofemoral Pain Syndrome and similar degenerative causes (chondromalacia, osteoarthritis). Although, the same or similar exercises can be used to treat most non-traumatic knee pain.

Can Patellar Tracking Play a Role in Knee Pain?

Short answer…Yes, sometimes. 

Long answer…As mentioned previously, you can have asymmetric weakness or tightness that adversely affects the tracking of your patella as it glides up and down the femoral groove. Every time that you bend and straighten your knee, your patella must be able to glide up and down (superiorly and inferiorly).

This patellar movement occurs regardless of whether you are walking, squatting, kneeling, and simply sitting and moving your leg from one position to another. Under normal conditions, the patella can glide unrestricted up and down in the groove. However, over time, excessive tightness or weakness can restrict and redirect this glide resulting in increased tissue irritation underneath the patella. 

This is what the medical world calls subpatellar pain (pain underneath the patella). Though, this is NOT where most people complain of their knee pain even though the pain may be originating from underneath. The pain is actually referred to around the outside edges of the patella (peripatellar pain). Someone would have a hard time “putting a finger on it” if asked to point to the source. It is also typically described as a dull, diffuse, ache-type pain. 

Check Your Patellar Mobility!

One potential indicator of a patellar tracking issue is to check your patellar mobility. In other terms, how well does your patella move freely within the femoral groove? This can easily be checked by lying in a long-sit position with your legs fully extended. The leg muscles must be completely relaxed in order to accurately assess the free patellar mobility. 

Grab both the inside and outside edges of the patella and try to gently tilt the patella inwards. This can be done by lifting up the outside, bottom edge of the patella while simultaneously pushing the inside edge downward. If it feels as though the patella does not tilt or the outside edge is “stuck” downwards, then it is likely that the IT Band (Iliotibial Band) is very tight on the outside of the leg, and holding the outside edge down in the femoral groove. 

In this case, using a foam roller or a massage stick roller would be a good choice to reduce the IT Band pull on the outside of the patella. This would then free up some movement in the patellar tracking allowing for decreased irritation in the cartilage underneath and promoting knee pain relief.

Is IT Band (Iliotibial) Tightness a Real Thing?

There are lots of discussions in the medical field discussing this topic. The IT Band is not muscular in nature as it is actually a long band of fascia that runs down the outside of the leg from the side of your pelvis, crossing the outside of the knee and inserting into the tibia bone below the knee.

The IT band has different tensile properties than muscle. So, when I speak to a patient regarding IT Band tightness with a patient I do describe that is actually tissue stiffness and not tightness within the structure. I find that most people can understand this concept and can “buy in” to the purpose behind the treatment protocol that I have developed for him/her.

Regardless, the IT Band stiffness/tightness needs to be addressed as it can directly affect the patellofemoral joint (the joint where the knee cap moves up and down in the femoral groove). Without treatment, IT Band Syndrome can develop causing outer knee pain. Foam rollers, hand massage rollers, or percussion massage devices can all be used to improve IT Band mobility.

My favorite tools for IT Band self-massage (myofascial release) are the following:

1. Best Beginner Foam Roller

   • Slightly softer, but won’t last quite as long with heavy use.
   

   9.6

   High-Density Foam Roller

   • AMAZON BASICS
   • IDEAL FOR BALANCE, STRENGTH, & FLEXIBILITY
   • FIRM, DURABLE POLYPROPYLENE
   • LIGHTWEIGHT
   • WIPES CLEAN EASY
   • 18 x 6 x 6 INCHES (LxWxH)

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2. Best Intermediate Foam Roller
   • This one is stiffer all-around but is better quality overall and will last several years.
   

   9.5

   OPTP Foam Roller

   • PROFESSIONAL QUALITY
   • 36-INCH ROLLER
   • SOFT DENSITY, COMFORTABLE COMPRESSION
   • VERSATILE FITNESS TOOL
   • MEASURES 36″ (LONG) X 6″ (DIAMETER)

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3. Best Advanced Foam Roller
   • Much harder material, but will last for years. For those who have experience with foam rolling already.
   

   9.8

   GRID Foam Roller

   • MULTI-DENSITY EXTERIOR OVER A RIGID, HOLLOW CORE
   • SUPERIOR FOAM ROLLER DESIGN
   • INCLUDES FREE ACCESS TO ONLINE INSTRUCTIONAL VIDEO LIBRARY

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4. Best Percussion Massager Device
   • I personally own one of these and they are awesome to use all over the body to reduce myofascial tension.
   

   9.7

   TheraGun Massage Gun

   • THERAGUN PRIME MASSAGE GUN
   • DEEP TISSUE MUSCLE RELIEF
   • 4 MASSAGE HEADS
   • PERCUSSIVE THERAPY
   • ULTRA QUIET
   • ERGONOMIC COMFORT

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5. Best Massage Stick Roller
   • I’ve been using it personally for years without any issue. This is a great tool to use for beginners as well since you’ll be able to control the amount of pressure you’re using much easier than when using a foam roller.
   

   9.8

   TheStick Original, 24"L

   • IDEAL FOR INDIVIDUALS OF ALL SIZES
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   • PROMOTES MUSCLE RECOVERY

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There needs to be a quick discussion on what someone should expect when using a foam roller, massager stick, or percussion device for massaging the IT Band. When someone first begins using one of these devices, they are usually shocked at how uncomfortable or even downright painful it can be along the leg.

I understand that it is not comfortable. However, if there are many painful spots within the IT Band, what I like to call “speed bumps or trigger points,” then that just tells you that the IT Band is very tight. This should give you some serious insight into just how tight the structures that cross your knee have gotten over time.

On the brighter side, you can look at it as there is a lot of room for improvement 😁

The tighter that the IT Band, the greater the pull on the patella it has as the patella is trying to glide up and down in the femoral groove whenever the knee is bending and straightening as discussed earlier. Think of these painful “speed bumps” as areas of tension within the IT Band that need to be relaxed from massage.

After committing to daily massage of these areas, there will be a noticeably smaller number of these painful “speed bumps” found during the foam rolling or stick rolling session.

What About Knee Osteoarthritis Pain?

Many of the same physical therapy knee exercises can be performed by someone with knee osteoarthritis (joint arthritis). Especially, when someone has osteoarthritis in the mild to moderate degenerative level, which would be confirmed via x-ray. If this were the case, just be sure to follow the key reminders below as you would never want to try and strengthen the knee through a painful range of motion, no matter the exercise. 

Check out my full, in-depth article on knee arthritis to learn about the progression of this degenerative disease and which physical therapy exercises can best help.

Which Muscles are the Most Important to Strengthen?

Knee exercises for pain relief should target the muscles that most directly support the knee joint. Our goal is to create the optimal environment for knee pain relief. The muscles that the knee exercises should strengthen are the quadriceps, hamstrings, and glute complex.

Exercise Frequency for Optimal Knee Pain Relief

Depending on your base level of fitness, knee strengthening exercises may be done every other day allowing for a rest or recovery day in-between. However, stretching exercises that promote improved muscular flexibility should be performed daily.

Also, it is important to take note of how irritable the knee symptoms are prior to starting these exercises. If the knee pain is a 9/10 intensity, then you should NOT start with strengthening exercises. Rather, you would begin by trying to reduce the irritability to a lower level, so that your knee can tolerate the exercises better once the irritation has decreased.

Rest, ice + elevation, gentle stretching, riding a recumbent bike with minimal resistance, and anti-inflammatory medications are some of the ways to promote decreased joint irritation.

Key Reminders!

Now that we have covered a base level of knowledge on this issue, we can discuss the best strengthening exercises for knee pain relief that I have found to treat overuse and degenerative knee pain. 

Rule #1: You must begin by strengthening the knee in a range of motion that is mostly pain-free! 

If you think that this is one of those “No Pain, No Gain” situations, you would be wrong.

The knee is different in that you must find a suitable range of motion in the painful joint that is pain-free, and then strengthen within that range until you find that you can go further without pain. This can be used as a good gauge of improvement as you should be able to notice that, as your strengthening program progresses through the next several days and weeks, the available pain-free range of motion with the exercises slowly increases.

Rule #2: Awareness of knee discomfort or pain is absolutely key!

The patellofemoral joint (the area where your patella glides within the femoral groove) is tricky sometimes. Patellar knee pain is often subtle in the form of a dull, achiness when performing certain potentially aggravating exercises. If you begin to feel an onset of this dull, achiness coming from under or around the patella during any leg strengthening exercise, it is imperative to do one of three things:

1. Shorten your knee range of motion within the exercise to find the area that is pain-free
   • Example 1: Reduce the depth of a squat from full depth to ½ depth or even 1/4 depth if necessary
   • Example 2: Reduce the overall range of knee extension exercises (straightening your knee) from a full range (knee bent 90° to fully straight) to ½ range (knee bent 90° to approximately 45°) or even just starting with an isometric hold within a pain-free bent knee position (usually around 80° of knee bend)
2. Reduce the intensity of the exercise by reducing weight or resistance
3. Stop the exercise altogether and find an alternative exercise that is pain-free